Rehabilitative Potential of Ayurveda for Neurological Deficits Caused by Traumatic Spinal Cord Injury

8/11/2019 Rehabilitative Potential of Ayurveda for Neurological Deficits Caused by Traumatic Spinal Cord Injury

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J Ayurveda Integr Med. 2014 Jan-Mar; 5(1): 5659.

doi: 10.4103/0975-9476.128868

PMCID: PMC4012364

Rehabilitative potential of Ayurveda for neurological deficits caused bytraumatic spinal cord injury

Sanjeev Rastogi

Department of Pancha karma, State Ayurvedic Col lege and Hospital, Lucknow University, Lucknow, Uttar Pradesh, India

Address for correspondence:Dr. Sanjeev Rastogi, State Ay urvedic College and Hospital, Tulsi Das Marg, Lucknow -226 004, Uttar

Pradesh, India. E-mail: [email protected]

Received April 16, 2013; Revised June 12, 2013; Accepted June 13, 2013.

Copyright: Journal of Ayurveda and Integrative Medicine

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported,

w hich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly c ited.

Abstract

Spinal cord injury (SCI) is associated with worst outcomes and requires a prolonged rehabilitation. Ayurvedic

indigenous methods of rehabilitation are often utilized to treat such conditions. A case of SCI was followed up for

3 months upon an Ayurvedic composite intervention and subsequently reported. The composite treatment plan

involved Ayurvedic oral medications as well as a few selected external and internalpancha karmaprocedures. A

substantial clinical and patient centered outcome improvement in existing neurological deficits and quality of life

was observed after 3 months of the Ayurvedic treatment given to this case.

Keywords:Practice-based evidence, patient centered outcome, quadriplegia, rehabilitation, spinal cord injury

INTRODUCTION

Traumatic spinal cord injury (SCI) causes severe devastations involving multiple domains affecting a healthy life.

Besides ambulatory and occupational deficits as per the injury level and intensity, it also leads to sensory and

autonomic deficits affecting the bladder and bowel regulation. As prolonged survival is the rule in most SCI,

rehabilitation has been increasingly recognized as an important measure in overall management of such conditions.

The primary goal of rehabilitation here is prevention of secondary complications, restoration of physical functioning

to the maximum, and adopting appropriate measures to utilize the existing functions to make the activities of daily

living (ADL) less dependent. Rehabilitation after SCI usually requires a multidisciplinary approach involving a

physician, a physiotherapist, an occupational therapist, a psychiatrist, a social worker, and nursing personnel

specialized in SCI care.[1,2] Seeing the limitations of current rehabilitative measures in improving the net outcomes

in SCI, a practice-based evidence (PBE) research has been stressed to underscore the practical measures

employed in various settings, which are found associated with improved net outcomes. Spinal cord injury

rehabilitation (SCIRehab) project and spinal cord Injury rehabilitation evidence (SCIRE) are examples of how a

PBE research can successfully be employed to identify the rehabilitation interventions most strongly associated

with positive outcomes.[3,4]

Ayurvedic hospitals and particularly thepancha karmaunits therein are found utilizing some indigenous

rehabilitative techniques to intervene in various neurological, muscular, and locomotory deficits. Common

conditions where such interventions recommended are neurological deficits caused by cerebrovascular accidents,
http://www.ncbi.nlm.nih.gov/pmc/about/copyright.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Rastogi%20S%5Bauth%5Dhttp://dx.doi.org/10.4103%2F0975-9476.128868http://www.ncbi.nlm.nih.gov/pmc/about/copyright.htmlmailto:dev@nullhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Rastogi%20S%5Bauth%5Dhttp://dx.doi.org/10.4103%2F0975-9476.128868


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cerebral atrophy, prolapsed intervertebral disc, and SCIs. The rehabilitative techniques adopted in such conditions

are composed of various classical heat and oil treatments done externally, oil and herbal decoction treatments

done internally in addition to oral therapies. Neurological, rheumatological, and degenerative joint disease together

form a substantial sum of total patients visiting an Ayurvedic hospital in India.[5] An overall satisfaction among

patients receiving such therapies has been observed in earlier studies.[6] Some pilot studies, case reports, and

case series have also reported the benefits of individual procedures or oral medications as interventions in such

conditions. Upon Pub Med search, nevertheless, we did not come across any report where Ayurvedic intervention

has been tried in a patient of SCI. Here we report a patient of SCI where an Ayurvedic comprehensive

management composed of a few rehabilitative procedures and oral Ayurvedic medications has resulted in

improvements identifiable through a SCI outcome measure like modified Barthel index (MBI).[7] The

observations noted on various outcome measures related to SCI have further been verified through clinical

examination and were endorsed during patient and care giver's interviews.

We presume that the observations as are reported in this case, upon their further substantiation may prove crucial

as a PBE substantiating to the management of SCI. Such PBE research may also come as a vital thrust to the

efforts made toward scientific substantiation and evidence-based reasoning aiming at effective and dependable

clinical practice of Ayurveda. Equally important, in contrast, this method of PBE generation would also be able to

mainstream many such interventions from traditional medicine, which remained unnoticed despite of their empirical

ability of generating improvements through patient-based outcome observation.

CASE REPORT

A 52-year-old previously healthy male suffered from a fall from stairs (about 10 feet height) (November 30, 2011

evening). He remained unconscious for about 1.5 hours following the fall and regained consciousness

subsequently. After getting awake he reported severe giddiness while raising the head and inability to move the

upper and lower limbs. He was attended by a family physician next morning and was prescribed a few

symptomatic medicine (prescription not available). On December 05, 2011 a noncontrast computed tomography

(CT) scan of head was performed, which revealed no significant finding. Failing to get any response from the

treatment, the patient was consulted with a neurosurgeon (December 22, 2011). Upon a detailed clinical

neurological examination done this time, he was noted for a quadriparesis with upper motor neuron (UMN)involvement more on the right side comparing to the left side. He was advised a hard collar, bowel and bladder,

and back care along with supportive therapy as may be recommended in the case from the point of view of

conventional medicine. Magnetic resonance imaging (MRI) cervical spine was advised this time and revealed

(January 02, 2012) straightening of cervical spine with desiccated intervertebral discs along with a fracture at C4

vertebral body. An intramedullary T2 hyper intensity was seen at C4 level, which was suggestive of cord

contusion. A disc bulge was observed at C3-4 level producing mild extradural compression over ventral aspect of

thecal sack with mild compromise of bilateral lateral races.

The conventional therapy continued for about 3 months following the injury, however, remained unrewarding.

Observing this, he was further consulted with another neurosurgeon and continued with subsequently

recommended therapy for another month. Failing to get any response he stopped taking the medicine. For next 3

months, the patient remained away from any direct medical supervision.

Ayurvedic intervention

On September 07, 2012 the patient was consulted by an Ayurvedic physician (SR) at State Ayurvedic College,

Lucknow. Upon this examination, it was revealed that he was unable to move either of the upper or lower limbs

and severe giddiness upon lifting the head. He was fully conscious and awake except that he was not able to move

any part of his body. His spine was stiff and so he was unable to turn on the bed or to sit even with support. There

was no autonomic dysfunction and the patient was able to feel the urge for micturition and defecation. There was


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no added sensory loss anywhere in the body [Table 1]. A MBI was found to be 4 this time.

Seeing the consistent request of the patient for Ayurvedic intervention in his case and considering his poor socio-

economic status rendering him unable to opt for any other conventional therapy, which might have been offered in

his case, the patient was taken up for Ayurvedic therapy. As there were no previous records of treating such

patients of SCI with Ayurvedic management, the patient and the relatives were explained about the experimental

nature of the therapy and the eventual uncertainty of the outcomes.

Considering the spastic condition of the whole body including spine and considering trauma to the cervical spine

and subsequent features pathognomonic to vata nanatmajadisease, the patient was recommended for a set of

Ayurvedic therapies comprising ofPinda Sweda(PS), Greeva Vasti(GV) with mahanarayanaoil and

Sarvanga Sweda(SS). In addition to these local therapies, the patient was also recommended a few oral

Ayurvedic drugs aiming at the control of vatain such clinical conditions [Table 2]. The whole treatment package

was provided to the patient in the indoor setting of State Ayurvedic College Hospital, Lucknow. The patient was

kept under continuous observation and was followed up on periodic basis. After one month of the therapy, little

improvement was observed in neurological deficits. Most remarkably the patient was able to raise his head without

complaint of giddiness as was noticed prior to the Ayurvedic treatment. After one month of therapy, to maximize

the therapeutic effects of the whole therapy the prescription was added with a periodicKaala Vasti(KV) with

mahanarayanaoil for 16 days and Shiro Vasti(SV) with brahmi ghrita[Tables 2and 3]. The same treatment

continued for another 2 months and the patient was followed up after the completion of the therapy. Upon a

subsequent follow-up after 3 months of Ayurvedic therapy, the patient was found to have substantial recovery to

his neurological deficits. He was able to turn on the bed unaided, able to sit unaided for 15-20 minutes and was

able to walk with major support. He was able to move all the joints of all the four limbs except the fine finger

movements at right hand. He was able to grip from the left hand and was able to eat with this hand. By this time he

was also able to stay out on wheel chair carried by some caregiver. A 10-item MBI score, which was reported to

be 4 before the start of Ayurvedic intervention, was improved to 10 at the end of 3 month Ayurvedic therapy. The

10-item MBI is intended to establish the degree of independence of the patient from any help, however, minor and

for whatever purpose. This is an index that records what the patient does rather than what the patient can do.

It is important to note here that a 20 score at MBI reflects the independence of patient in cases of SCI. Aninterview with patient and his care givers reflected their satisfaction with the outcome achieved in 3 months of

therapy with an expectation to obtain more if the therapy is further continued.

Details of the ayurvedic procedure s

Ayurvedic therapy was started with PS for 15 minutes done with the help of a rice bolus made up of rice boiled in

milk and dashamula quath. A prior whole body massage with mahanarayanaoil was done before PS. A

subsequent GV was done with the help of lukewarm mahanarayanaoil poured upon cervical spine within a

confined area marked through a small well made up of mashflour. Subsequently, asarvanga swedanafor 5

minutes was done with dashamula quath.

In the following month KV was added to the treatment in a schedule of 16 vastiscomprised of one anuvasana

followed by six anuvasanaand six niruha vastiand finally followed by three anuvasana vasti.Anuvasana

vastiwas given after meal and composed ofsaindhavasalt 5 g, honey 10 g, mahanarayanoil 30 ml, and

dashamula quath30 ml.Niruha vastiwas given empty stomach and was composed ofsaidhavasalt 10 g,

honey 10 g, mahanarayanaoil 30 ml and dashmula quath150 ml. The vasticomponents were mixed in order

and given as mentioned in the classical texts of Ayurveda. This time the patient was also started with SV with

brahmi ghritato intensify the vata shamakaeffects of the whole therapy. SV was done for 30 minutes every

day. No other specific therapy either biomedical or physiotherapy was instituted during the trial period.

DISCUSSION
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012364/table/T3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012364/table/T2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012364/table/T2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012364/table/T1/


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SCI have been one among the most devastating trauma man can suffer. The worst victims of SCI are those

suffering with quadriplegia associated with autonomic dysfunction. As long-term survival is the rule in most cases

of SCI and as the victims of SCI are prominently the young people in their most productive age, the personal and

social impacts of such trauma are extremely deleterious. Immediate surgical decompression is often been

recommended as the first measure to minimize the neurological damage caused by vertebral fractures and the

results are not found very satisfactory if this decompression is delayed. A substantially high cost of surgical

approach in SCI nevertheless is a major limitation in frequent utilization of this option in every SCI case. Absence

of definitive conservative therapy to intervene and high cost associated with surgical approaches makesrehabilitative approach crucial for SCI sufferers in making them less dependent and improving their performance

level of primary ADL. Any neurological improvement following the immediate or delayed conservative intervention

after the spinal cord trauma is also something which is being desperately looked in such conditions. Ayurvedic

treatment as an advent of orient with its global outreach offers substantial help to deal with such situations through

its own indigenous treatment models. Various oil andghritatherapies of Ayurveda have been able to give

substantial improvement in many intractable neurological conditions as are reported in various single case reports

and series published from time to time.[8,9] This case of SCI presented with severe neurological deficits and a

MBI score of 4 has demonstrated the clinical and patient centered outcome improvements after 3 months of a

comprehensive Ayurvedic therapy. MBI scoring is used as a dependable index to know about the qualitative

improvements in SCI patient's life by observing the level of independence achieved after the therapy. A 10 itemMBI has a range of scores 0-20 where 0 denotes a complete dependence and 20 denotes a complete

independence. Any shift in the net score favoring toward the higher scores is indicative of decreasing dependence

and increasing independence as it was observed in this case. Although the treatment was not able to bring a

complete independence of functions in the case it certainly had reduced the level of dependence as was

observable with the improved MBI score. This case offers two important bearings to current medical practice

pertaining to SCI. First it offers a novel approach of managing the neurological deficits of patients suffering with

SCI once it is stabilized. Either alone or in conjunction with conventional rehabilitative measures, this approach

upon its further substantiation, holds a promise of adding benefits into the currently utilized protocol of SCI

management. Second and equally important bearing of this case report is to express the utility of Ayurveda as a

composite intervention for the purpose of clinical practice and research. The case presented here has been treatedwith a comprehensive and composite management plan as per the convenience of Ayurveda. As the treatment was

able to make improvements in existing conditions, this approach should be taken into consideration while making

any further trial to treat similar or new conditions with the help of Ayurveda.

Footnotes

Source of Support:Nil,

Conflict of Interest:None declared.

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Figures and Tables

Table 1

Neurological finding in a case of SCI before and after the ayurvedic therapy

Table 2


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Ayurvedic treatment given to a case of spinal cord injury

Table 3

Composition of Ayurvedic therapy utilized for rehabilitation in a case of SCI

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Rehabilitative Potential of Ayurveda for Neurological Deficits Caused by Traumatic Spinal Cord Injury